Service Billing
code
Payer and
amount
Description

CPT
96160

Medicaid
$3
  • Administration and interpretation of a health risk assessment instrument
G0442 Medicare
$17
  • Screening for alcohol use in adults once per year. No coinsurance; no deductible for patient.
G0443 Medicare
$
  • Up to four, 15-minute, face-to-face brief interventions per year for individuals who screen positive for unhealthy alcohol use. No coinsurance; no deductible for patient.
G2011 Medicare
$16
  • 5-14 minutes of aggregate clinic time spent administrating and interpreting a validated alcohol or drug screening tool, plus performing a face-to-face brief intervention the same day.
CPT
99408
Medicaid
$23-27
  • Same as above, if 15-29 minutes
G0396 Medicare
$33-35
CPT
99409
Medicaid
$47-53
  • Same as above, if ≥30 minutes
G0397 Medicare
$64-66

Notes:

Not all codes are approved for use in all states.  CPT codes above should be appended to E/M service with modifier 25. Payment amounts are estimates only.

ICD-10 diagnosis codes are poorly suited for most SBIRT patient scenarios, and may break confidentiality with adolescent patients when parents read billing documents. Sometimes Z13.89 (“Encounter for screening for other disorder” or Z13.9 (“Encounter for screening, unspecified”) is used.

Screening tools approved by the Oregon Health Authority (Medicaid) for reimbursement are listed here. Note that the Brief screen (single alcohol and drug questions) is not reimbursable.

Independent billing:

Only the following licensed professionals are allowed to bill the above codes independently:

Oregon Medicaid:
  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors
  • Licensed Marriage and Family Therapists

Medicare:
  • Physicians (MD, DO only)
  • Physician Assistants
  • Nurse Practitioners
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers
  • Certified Nurse Midwives
  • Clinical Nurse Specialists

Incident-to billing under Oregon Medicaid:

Under Oregon Medicaid, any clinic employee or contractor acting under the supervision of a licensed and credentialed provider may be able to receive reimbursement for screening and brief intervention services, under incident-to rules. Examples of these individuals include (not an exhaustive list):

  • Certified alcohol and drug counselors (CADCs), medical assistants, nurses, health educators, community health workers, wellness coaches, students or graduates entering medical professions.

Incident-to billing rules may not apply towards all SBIRT workflows or settings. It is best to check with a billing specialist beforehand for guidance. Medicaid rules are subject to change, and providers should follow Oregon's Administrative Rules as it relates to Medicaid billing guidelines.

More billing information:

Oregon Health Authority (Medicaid)
Medicare